Plastic Surgery Research Council

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The Impact of Smoking on Postoperative Complications in Hand Surgery
Brian H. Cho, MD, Keith T. Aziz, MD, Aviram M. Giladi, MD, MS.
The Curtis National Hand Center, Baltimore, MD, USA.

PURPOSE: Smoking is a prevalent modifiable risk factor that has been shown to negatively impact wound healing. Across numerous surgical specialties adverse postoperative outcomes have been linked to smoking. In this study, we examine the impact of smoking on short term (30-day) complications in patients undergoing hand surgery procedures.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data sets were queried for all patients who underwent hand surgery from 2011 to 2016. Cases were divided into smoking and nonsmoking cohorts and compared in terms of demographic characteristics, comorbidities, and postoperative complications. Multivariable logistic regression models were used to control for patient demographics and comorbidities in assessing the association between smoking and post-operative infections as well as other major and minor complications.
RESULTS: Of the 48,370 patients who underwent hand surgery from 2011 to 2016, 22% (N=10,577) of patients reported active smoking. Compared to nonsmokers, smokers were more likely to be younger (45 vs. 53 years, P<0.05), male (55% vs. 42%, P<0.001), and have a lower body mass index (26.9 vs. 27.8, P<0.001). Additionally, they were more likely to have a higher American Society of Anesthesiologists (ASA) classification (2.1 vs. 1.9, P<0.001), and report dyspnea (P<0.001) and chronic obstructive pulmonary disease (COPD) (P<0.001). Multivariable logistic regression analysis identified smoking as an independent risk factor for major complications (odds ratio; 1.34, 95% CI, 1.09-1.63; P=0.005) and infection (odds ratio; 1.37, 95% CI, 1.14-1.64; P=0.001). Smoking was not associated with a risk for minor complications (odds ratio; 1.09, 95% CI, 0.89-1.33, P=0.40.)
CONCLUSIONS: Despite a decreasing prevalence of smoking among U.S. adults, a substantial proportion of patients undergoing hand surgery are smokers. These patients may be at a significantly higher risk of major complications and infections than nonsmokers. Preoperative smoking cessation may help mitigate the risk of postoperative complications after hand surgery.


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